Pathology/Lab Coding Alert

Waiving deductible may increase usage.

If your lab performs certain screening tests for Medicare beneficiaries, such as Pap tests or some colorectal cancer fecal assays, changes in the 2011 Physician Fee Schedule (PFS) Final Rule might boost demand for your work.

The 2011 PFS will "eliminate out-of-pocket costs for most preventive services beginning January 1, 2011, reducing barriers to access for many beneficiaries," according to CMS administrator Donald Berwick, MD.

Patients No Longer Pay For Some Tests

The 2011 PFS expands Medicare coverage to encourage the use of "preventive services," in accordance with Congressionalmandate. Among other things, "Congress removes some of the Part B cost-sharing obligations to encourage patients to obtain certain of these services," the PFS states.

For certain lab services, that means patients will no longer be required to pay any deductible amount, beginning Jan. 1.

The following lab tests move from 2010 payment status of "coinsurance applies and deductible is waived," to 2011 payment status of "waived:"

• G0124 -- Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician)
• G0141 -- Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
• P3001 -- Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician
• G0328 -- Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous

That means patients have no cost exposure for abnormal Pap test interpretation or immunoassay fecal occult blood test (FOBT), which may increase patient compliance with screening recommendations and thus test utilization in your lab.

CMS Already Waives Many Screening Tests

Although the 2011 PFS enhances screening test coverage with the preceding changes, you should realize that Medicare already fully pays for nearly 20 other lab tests for preventive medicine screening services.

For instance: Medicare pays for screening lab tests to aid in early detection of cardiovascular disease, diabetes, and cervical or prostate cancer, among other conditions. The following tests are just a few examples of tests your lab might receive for Medicare beneficiary preventive services:

• 80061 -- Lipid panel
• 82951 -- Glucose; tolerance test (GTT), three specimens (includes glucose)
• 82270 -- Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single tirple card for consecutive collection)
• G0103 -- Prostate cancer screening; prostate specific antigen test (PSA)
• G0432 --" Infectious agent antigen detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening

For a complete list of covered preventive medicine codes, see the 2011 PFS in the Nov. 29 Federal Register at      edocket.access.gpo.gov/2010/pdf/2010-27969.pdf.